Hypertension Management case study

Hypertension Management Submitted by Shannon Delite Leake The University of Texas at Arlington College of Nursing In partial fulfillment of the requirements of Advanced Pharmacology N5334 Mary Davis, DNP, MSN, RN, APN-BC, CRNP, ADM-BC October 26, 2017 Hypertension Management 1 Hypertension Management CASE SUMMARY: Mr. James Franks is a 64-year-old African-American male. Presents today with complaints of occasional headache. Mr. Franks has a 14-year history of hypertension with co-morbid diagnoses of diabetes mellitus type 2 for 16 years, COPD GOLD 3/group c, Benign Prostatic Hypertrophy (BPH), Chronic Kidney Disease (CKD), and Gout. He has been taking Naproxen Sodium to relieve gout pain. Plan of care today will focus on Mr. Franks hypertension, with reeducation to lower salt intake, education to not consume alcohol with current medications, weigh daily while on diuretic and report losses and gains of three pounds daily and five pounds in one week, and refer to home health for nurse to educate patient on medications and manage medications administration times, monitor vital signs, monitor for adverse side effects, and educate on disease process. 5334 CASE SUMMARY TABLE 1. Symptoms: List two pertinent signs and symptoms Headache Dizziness 14-year history of hypertension with current blood pressure readings in office 162/90 sitting and 164/92 standing 2. Recommended Drugs: **Drug of choice – list at least 3 recommended drugs List recommended drugs as indicated for this diagnosis  Demadex (Torsemide) 2.5–5 mg once daily, may increase to 10 mg once daily after 4–6 wk (Vallerand, Deglin, & Sanoski, 2017).  Prinivil, Zestril (Lisinopril) 10mg daily with Creatinine Clearance (CCr) of 60mL/minute, 5mg daily CCr of 30 – 60mL/minute, 2.5mg daily CCr of 10 – 2 Hypertension Management 30mL/minute (Vallerand, Deglin, & Sanoski, 2017).  Norvasc (Amlodipine) 5 – 10mg daily (Vallerand, Deglin, & Sanoski, 2017).  Tylenol (Acetaminophen) 500mg one to two tabs every six hours as needed for pain (Vallerand, Deglin, & Sanoski, 2017). 3. Drug Categories and Subcategories: Identify the category of each recommended drug.  Demadex (Torsemide) is therapeutically an antihypertensive, pharmacologically a loop-diuretic, and a pregnancy B category medication (Vallerand, Deglin, & Sanoski, 2017).  Prinivil, Zestril (Lisinopril) is therapeutically an antihypertensive and pharmacologically classified as an angiotensin-converting enzyme and a pregnancy category D medication (Vallerand, Deglin, & Sanoski, 2017).  Norvasc (Amlodipine) is therapeutically an antihypertensive and pharmacologically a Calcium Channel Blocker and is a pregnancy category C medication (Vallerand, Deglin, & Sanoski, 2017).  Tylenol (Acetaminophen) therapeutically a non-opioid pain reliever and an antipyretic and a pregnancy B category medication (Vallerand, Deglin, & Sanoski, 2017). 4. Drug(s) of Choice: FOR THE MAIN DIAGNOSIS ONLY, provide the chosen drug(s) of choice for treatment. 5. Rationale: Provide rationale, clinical guidelines, or evidence for the selected drug of choice  Demadex (Torsemide) blocks the active reabsorption of sodium and does not have a 3 Hypertension Management profound effect on the glomerular filtration rate (Vadivelan, 2013).  Prinivil, Zestril (Lisinopril) Angiotensin-Converting Enzymes are recommended in those hypertensive individuals with concomitant diagnoses of DM and CKD (NKF, n.d.).  Tylenol (Acetaminophen) Non-Steroid Anti-Inflammatory Drugs carry a greater risk to increase blood pressure at levels for pain relief (NSAIDs, n.d.). 6. Contraindications and or Risks, as appropriate: Identify contraindications and risks as appropriate  Demadex (Torsemide) hypersensitivity; cross-sensitivity may occur with thiazides and sulfonamides; use with caution in sever liver disease as a potassium sparing diuretic may be needed in conjunction, decreased electrolytes, diabetes, increased azotemia, the elderly as they may have an increased risk of side effects like hypotension and electrolyte imbalances, pregnancy, lactation, and pediatric populations (Vallerand, Deglin, & Sanoski, 2017).  Prinivil, Zestril (Lisinopril) hypersensitivity, a history of angioedema previously, concurrent use of aliskiren in individuals with diabetes or CKD with CCr less than 60mL/minute, do not use in pregnancy as fetal death can occur, do not breastfeed; use cautiously in renal impairment, hepatic impairment, concurrent diuretic therapy, as a monotherapy in African American patients, hyponatremia, hypovolemia, women of childbearing age, surgery, anesthesia, excessive hypotension may occur when used with other antihypertensive medications or diuretics (Vallerand, Deglin, & Sanoski, 2017).  Tylenol (Acetaminophen) previous hypersensitivity; consumption of alcohol, aspartame, saccharine, yellow dye number five, sugar, tartrazine, active liver disease, hepatic impairment (Vallerand, Deglin, & Sanoski, 2017). 4 Hypertension Management 7. What Patients Must Understand: Identify at least 3 appropriate teaching points for the patient and/or family (HINT: 3 teaching points is rarely adequate for good patient care) Demadex (Torsemide)  Side effects/Adverse reactions include: Dermadex (Torsemide) headache, dizziness, hypotension, nervousness, ringing of the ears, hearing loss, constipation, diarrhea, dry mouth, vomiting, indigestion, increased blood urea nitrogen, increased urination, hyperglycemia, rash, Steven’s Johnson Disease, light sensitivity, hyperuricemia, hypocalcemia, hyponatremia, metabolic acidosis, dehydration, hypovolemia, Toxic Epidermal Necrolysis, hypokalemia, hypomagnesemia, arthralgia, hypochloremia, myalgia, and muscle cramps (Vallerand, Deglin, & Sanoski, 2017). Prinivil, Zestril (Lisinopril) dizziness, headache, fatigue, drowsiness, vertigo, weakness, cough, dyspnea, vomiting, anorexia, tachycardia, chest pain, edema, abdominal pain, taste disturbances, problems getting, or maintaining erections, constipation, diarrhea, hyperuricemia, renal dysfunction, renal failure, rashes, proteinuria, flushing, pruritis, hyperkalemia, angioedema, agranulocytosis, muscle pain, back pain, myalgia (Vallerand, Deglin, Sanoski, 2017). Demadex (Toresemide) increases low blood pressure when used with other blood pressure medications, nitrates or consumption of alcohol take blood pressure prior to taking and avoid drinking alcohol; use of NSAIDs such as aspirin, naproxen sodium, and ibuprofen may decrease the effects of this medication and increase your risk of salicylate poisoning (Vallerand, Deglin, & Sanoski, 2017). Tylenol (Acetaminophen) agitation, headache, anxiety, fatigue, atelectasis, insomnia, difficulty breathing, hepatoxicity, hypotension, hypertension, constipation, nausea, increased liver enzymes, vomiting, hypokalemia, renal failure in chronic use of high doses, 5 Hypertension Management neutropenia, pancytopenia, trismus, Steven’s Johnson’s Disease, muscle spasms, rash, Acute Generalized Exthematous Pustulosis, Toxic Epidermal Necrolysis, urticaria (Vallerand, Deglin, & Sanoski, 2017).  Avoid using salt substitutes and foods with high potassium unless directed by your primary care provider (Vallerand, Deglin, Sanoski, 2017).  Take Demadex (Torsemide) as directed, take missed doses as soon as you have missed them unless it is close to the next dose, do not double doses (Vallerand, Deglin, & Sanoski, 2017).  Take Lisinopril as directed at the same time every day even if you are feeling well, take any missed doses as soon as you notice unless it is time for your next dose, do not double up on dose, and do not stop taking unless directed to do so (Vallerand, Deglin, & Sanoski, 2017).  Avoid driving and other activities that require you to be mentally alert until you know how you react on Lisinopril (Vallerand, Deglin, & Sanoski, 2017).  Change positions slowly and allow yourself time to get acclimated to the new position prior to walking to decrease your chances of sudden low blood pressure (Vallerand, Deglin, & Sanoski, 2017).  Avoid drinking alcohol, exercising in hot weather, or standing for long periods of time as this will increase your chance of low blood pressure (Vallerand, Deglin, & Sanoski, 2017).  When you first start taking Lisinopril you may notice a change in how things taste, this usually subsides after eight to 12 weeks with continued therapy (Vallerand, Deglin, & Sanoski, 2017).  If you are scheduled for surgery it is important for you to advise the surgeon of use of Lisinopril (Vallerand, Deglin, & Sanoski, 2017).  Weigh daily and contact the office if you gain two to three pounds in one day (Vallerand, Deglin, & Sanoski, 2017).  Do not take any over-the-counter medications, including herbal and vitamin